2020 Healthcare Enforcement Compliance Conference

Medical Necessity and Civil and Criminal Liability

  • Medical Necessity and Civil and Criminal Liability

    Judy Ringholz, Vice President of Compliance and Ethics & Chief Compliance Officer, Jackson Health System . Jeffrey Dickstein , Partner, Phillips & Cohen LLP. Alison Rousseau , Senior Trail Counsel for Health Care Fraud, U.S. DOJ . Brian Bewley , Partner, Life Sciences and Healthcare , 32.

    November 18, 2020

    • Medical necessity cases are very much alive in the FCA world, though the environment is ever-changing. This panel, consisting of an attorney in DOJ’s Civil Division, a health system chief compliance officer, defense counsel and relator’s counsel will examine the evolving landscape

    • We will consider the primary legal issues involved in medical necessity cases, recent relevant court rulings, as well as the regulations typically in play in common questions of medical necessity

    • We will discuss when fraudulent conduct becomes criminal conduct in cases alleging medically unnecessary testing and/or procedures

    • Do robust compliance measures prevent medical necessity cases? Do aggressive defense tactics head them off? We will examine the effect of compliance and defense strategy on DOJ investigations of allegations of lack of medical necessity

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The Society of Corporate Compliance and Ethics (SCCE) is a non-profit, member-based professional association. SCCE supports our members' work with education, news, and discussion forums. We are a community of leaders, defining and shaping the corporate compliance environment across a wide range of industries and geographic regions. In developing and maintaining effective ethics and compliance programs, our members strengthen and protect their companies.

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About HCCA

The Health Care Compliance Association (HCCA), is a 501(c)6 non-profit, member-based professional association. HCCA was established in 1996 and is headquartered in Minneapolis, MN. We provide training, certification, and other resources to over 10,000 members. Our members include compliance officers and staff from a wide range of organizations, including hospitals, research facilities, clinics and technology service providers.

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